scholarly journals Intraoperative Surgical Complications in Transoral Laser CO2 Microsurgery of the Larynx: An Observational, Prospective, Single-Center Study

2019 ◽  
pp. 014556131988278
Author(s):  
Carlos Miguel Chiesa-Estomba ◽  
Jon Alexander Sistiaga-Suarez ◽  
Jose Angel González-García ◽  
Ekhiñe Larruscain ◽  
Xabier Altuna-Mariezcurrena
Keyword(s):  
Intraoperative Complications ◽  
Tumor Resection ◽  
Major Complication ◽  
Preoperative Assessment ◽  
Oncologic Outcomes ◽  
Anatomical Location ◽  
Complication Rates ◽  
Inclusion Criteria ◽  
Prospective Data ◽  
Single Center Study

Introduction: Despite good outcomes of CO2 laser of the larynx, a lack of prospective data related to intraoperative complications in the indexed literature is evident. Materials and Methods: An observational, prospective, nonrandomized study. Results: One hundred and twenty-eight patients met the inclusion criteria. The total rate of intraoperative complications was 14.8% (19/128). The rate of complications according to anatomical location was 7 (38.8%) of 18 for supraglottic tumors and 11 (10.3%) of 107 for glottic tumors, and 1 (33.3%) of 3 for subglottic tumors ( P = .001). We do not found difference in complications according to severity (minor vs major complication). Conclusion: Previous studies reported good oncologic outcomes and low complication rates with CO2 transoral laser microsurgery (TOLMS) compared to traditional open surgery. However, it is important to consider the different intraoperative surgical, major and minor complications related to CO2 TOLMS and discuss this with our patients during the preoperative assessment, especially in those patients who need a supraglottic tumor resection.

scholarly journals Absorbable Self-Retaining Barbed Double-Needle Suture(SRBDS) in Transperitoneal Laparoscopic Partial Nephrectomy for T1 Renal Neoplasms

2021 ◽  
Author(s):  
HaiBin Wei ◽  
YuChen Bai ◽  
Qi Zhang ◽  
ZuJie Mao ◽  
EnHui Li ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Intraoperative Complications ◽  
Tumor Resection ◽  
Oncologic Outcomes ◽  
Renal Neoplasm ◽  
Renal Neoplasms ◽  
Selective Embolization ◽  
Bleeding Vessel ◽  
Estimated Blood Loss ◽  
Post Operation

Abstract ObjectiveTo evaluate the safety and hemostatic efficacy of absorbable self-retaining barbed double-needle suture (SRBDS) in transperitoneal LPN for T1 renal neoplasms.MethodsIn total, 75 patients with renal neoplasm masses (< 7 cm) undergoing transperitoneal LPN were collected since January 2018 to October 2019. After tumor resection with a cold Endoscissor, 3-0 and 0 SRBDS was performed for inner and outer running stitches without either hem-o-lok or LapraTy clip, respectively. Patient demographic information, neoplasm characteristics, perioperative factors, and oncologic outcomes were collected and analyzed.ResultsAccording to our result, Median tumor size and R.E.N.A.L score was 4.69 cm and 7. Median operative time and overall warm ischemia time was 73 min and 13.14 min. Mean estimated blood loss was 67 ml. intraoperative complications was not showing up and no case was switched to open radical nephrectomy. Postoperative pathological assessment confirmed that negative surgical margins. only single patient experienced secondary surgery-related hemorrhage on the fifth day post-operation, and was treated by transfusion and digital subtraction angiography (DSA) highly selective embolization of the bleeding vessel. No patients developed urinoma or urinary fistula. the overall complications were manageable during three-year follow-up period.ConclusionSRBDS was a safe and efficient surgical endoscopic suturing technique with low complication rate in T1 renal neoplasms, which might be considered as an alternative to other suturing techniques, tissue sealants and glues for partial nephrectomy in the future.

scholarly journals Absorbable self-retaining barbed double-needle suture(SRBDS) in transperitoneal laparoscopic partial nephrectomy for T1 renal neoplasms

2020 ◽  
Author(s):  
Hai-bin Wei ◽  
Yu-chen Bai ◽  
Qi Zhang ◽  
Zu-jie Mao ◽  
En-hui Li ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Intraoperative Complications ◽  
Tumor Resection ◽  
Oncologic Outcomes ◽  
Renal Neoplasm ◽  
Renal Neoplasms ◽  
Selective Embolization ◽  
Bleeding Vessel ◽  
Estimated Blood Loss ◽  
Post Operation

Abstract PurposeThe purpose of study was to evaluate the safety and hemostatic efficacy of absorbable self-retaining barbed double-needle suture (SRBDS) in transperitoneal LPN for T1 renal neoplasms.MethodsIn total, 75 patients with renal neoplasm masses (< 7 cm) undergoing transperitoneal LPN were collected since January 2018 to October 2019. After tumor resection with a cold Endoscissor, 3-0 and 0 SRBDS was performed for inner and outer running stitches without either hem-o-lok or LapraTy clip, respectively. Patient demographic information, neoplasm characteristics, perioperative factors, and oncologic outcomes were collected and analyzed. ResultsAccording to our result, Median tumor size and R.E.N.A.L score was 4.69 cm and 7. Median operative time and overall warm ischemia time was 73 min and 13.14 min. Mean estimated blood loss was 67 ml. intraoperative complications was not showing up and no case was switched to open radical nephrectomy. Postoperative pathological assessment confirmed that negative surgical margins. only single patient experienced secondary surgery-related hemorrhage on the fifth day post-operation, and was treated by transfusion and digital subtraction angiography (DSA) highly selective embolization of the bleeding vessel. No patients developed urinoma or urinary fistula. the overall complications were manageable during three-year follow-up period. ConclusionSRBDS was a safe and efficient surgical endoscopic suturing technique with low complication rate in T1 renal neoplasms, which might be considered as an alternative to other suturing techniques, tissue sealants and glues for partial nephrectomy in the future.

634 ROBOTIC-ASSISTED HIATAL HERNIA AND GASTROESOPHAGEAL DISEASE SURGERY: INITIAL RESULTS AND EXPERIENCE IN A SINGLE INSTITUTION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Sara Sentí Farrarons ◽  
Arantxa Clavell Font ◽  
Cristina Albero Bosch ◽  
Marta Viciano Martin ◽  
Elisenda Garsot Savall
Keyword(s):  
Hiatal Hernia ◽  
Intraoperative Complications ◽  
Major Complication ◽  
Common Disease ◽  
Complication Rates ◽  
Robotic Approach ◽  
Mediastinal Dissection ◽  
Urgent Surgery ◽  
Total Fundoplication ◽  
The Mean

Abstract   Gastroesophageal reflux disease, associated with sliding or large paraesophageal hiatal hernia, represents a common disease that frequently needs a surgical solution. The repair of large paraesophageal hiatal hernias is still a challenge in minimally invasive surgery but the robotic approach seems to gain widespread acceptance because offers enhanced visualization, dexterity and reach, which may facilitate the hiatal reconstruction and mediastinal dissection. Methods Between June 2019 and February 2021, 23 patients (5 male, 18 female) underwent robotic approach fundoplication (19 sliding hernia, 3 paraesophageal and 2 gastroesophagic reflux) after being pre operative diagnosed. All surgeries were elective. Biosynthetic tissue absorbable mesh was applied in one patient with double time recurrence hernia. Sixteen patients underwent total fundoplication (Nissen), 6 patients had Toupet fundoplication, and one patient had hiatus repair without fundoplication. Results The mean age of the patients was 61 years. Biosynthetic mesh was used in one patient. The mean operative time was 127 minutes (80-240) and no intraoperative complications were described. There were no conversions to open or laparoscopic procedures. Nine of the twenty-three patients underwent redo hiatal hernia repairs and the mean hospital stay was 2 days. Only one patient had a major complication (Clavien Dindo 3b) requiring urgent surgery. The early and 30 day mortality rate was 0%. Conclusion In our experience, robotic approach to paraesophageal repair seems safe and effective with low complication rates even in high-risk patients and those with redo surgery. Subjectively, the robotic approach provides the surgeon better vision and maneuverability during the intervention. We hope to progressively increase the number of robotic cases to analyse long-term clinical outcomes such as hiatal hernia recurrences, need of medical therapy and quality of life.

scholarly journals Transoral Carbon Dioxide Microsurgery of the Larynx as a Day-Case Outpatient Procedure: An Observational, Retrospective, Single-Center Study

2020 ◽  
Vol 100 (1_suppl) ◽  
pp. 100S-104S
Author(s):  
Carlos M. Chiesa-Estomba ◽  
Jon A. Sistiaga Suarez ◽  
Elisabeth Ninchritz-Becerra ◽  
Maria Soriano-Reixach ◽  
Jose A. González-García ◽  
...  
Keyword(s):  
Randomized Study ◽  
Preoperative Assessment ◽  
Statistical Correlation ◽  
Laryngeal Edema ◽  
Inclusion Criteria ◽  
Day Case ◽  
Outpatient Procedure ◽  
Common Location ◽  
Single Center Study ◽  
The Mean

Introduction: Despite good results of transoral laser CO2 microsurgery (CO2TOLMS) of the larynx, a lack of data related to the safety of this technique as a day-case procedure across the literature is evident. Materials and Methods: An observational, retrospective, non-randomized study. Results: One hundred four (62.6%) patients met the inclusion criteria, 96 (92.3%) patients were male, and 8 (7.7%) patients were female. The mean age of the study group was 66 ± 11 years (min: 34/max: 90). All the patients underwent CO2TOLMS were treated as an outpatient procedure. The glottis was the most common location affecting 97 (93.3%) patients, regarding the need of readmission, just 4 (3.8%) patients needed to be readmitted after surgery due to dyspnea secondary to laryngeal edema in 2 cases by laryngeal bleeding, and cervical emphysema in one case, respectively. Being just necessary to reintubate 1 patient (<1%) to control the bleeding. We didn’t find any statistical correlation between variables and the need for readmission of reintubation. Conclusion: According to our results, CO2TOLMS of the larynx can be safely performed as an outpatient procedure. To establish a proper protocol and to perform a careful preoperative assessment are essential to increase our success rate and to prevent any potential complication.

Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study

2020 ◽  
Author(s):  
Antonio Klasan ◽  
Sven Edward Putnis ◽  
Wai Weng Yeo ◽  
Darli Myat ◽  
Brett Andrew Fritsch ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Selection ◽  
Knee Arthroplasty ◽  
Major Complication ◽  
The Elderly ◽  
Complication Rates ◽  
Bilateral Total Knee Arthroplasty ◽  
Proper Patient Selection ◽  
Patient Reported ◽  
Total Knee

AbstractDespite multiple studies, there remains a debate on the safety of bilateral total knee arthroplasty (BTKA) in the average age patient, with a paucity of data on the outcome of BTKA in an elderly population. This study included 89 patients aged 80 years and older undergoing sequential BTKA over 14 years were identified in a prospectively collected database. Two matched comparison groups were created: patients under 80 undergoing sequential BTKA and patients over 80 undergoing unilateral TKA (UTKA). An analysis of complications, mortality, revision, and patient-reported outcome measures was performed. Mean age of the elderly cohorts was similar: 82.6 for BTKA and 82.9 for UTKA. The average age BTKA cohort had a mean age of 69.1. Complication rates were higher in bilateral cohorts, more so in the elderly BTKA cohort. Pulmonary embolism (PE) was observed in bilateral cohorts only. In these patients, history of PE and ischemic heart disease was a strong predictive factor for developing a major complication. There was no difference in revision rates and infection rates between the three cohorts, and no difference in patient survivorship between the two elderly cohorts. Through the combination of low revision and high survivorship rates and comparable clinical outcomes, this article demonstrates that simultaneous BTKA is an appropriate option to consider for an elderly patient, with proper patient selection and perioperative management. The demonstrated risk groups show that emphasis on patient selection should be focused on medical history rather than chronological age.

A Novel Surgical Technique for Large Frontoencephalocele Management: The Mercy Ships Approach

FACE ◽  
2021 ◽  
pp. 273250162097932
Author(s):  
Naikhoba C. O. Munabi ◽  
Eric S. Nagengast ◽  
Gary Parker ◽  
Shaillendra A. Magdum ◽  
Mirjam Hamer ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Intraoperative Complications ◽  
Complication Rates ◽  
The Novel ◽  
Middle Income ◽  
Middle Income Countries ◽  
Lumbar Drain ◽  
Cerebral Herniation ◽  
Long Nose

Background: Large frontoencephaloceles, more common in low and middle-income countries, require complex reconstruction of cerebral herniation, elongated nose, telecanthus, and cephalic frontal bone rotation. Previously described techniques involve multiple osteotomies, often fail to address cephalad brow rotation, and have high complication rates including up to 35% mortality. This study presents a novel, modified, single-staged technique for frontoencephalocele reconstruction performed by Mercy Ships. This technique, which addresses functional and aesthetic concerns with minimal osteotomies, may help improve outcomes in low resources settings. Methods: Retrospective review was performed of patients who underwent frontoencephalocele reconstruction through Mercy Ships using the technique described. Patient data including country, age, gender, associated diagnoses, and prior interventions were reviewed. Intraoperative and post-operative complications were recorded. Results: Eight patients with frontoencephalocele (ages 4-14 years) underwent surgery with the novel technique in 4 countries. Average surgical time was 6.0 ± 0.9 hours. No intraoperative complications occurred. Post-operatively 1 patient experienced lumbar drain dislodgement requiring replacement and a second had early post-operative fall requiring reoperation for hardware replacement. In person follow-up to 2.4 months showed no additional complications. Follow-up via phone at 1 to 2 years post-op revealed all patients who be satisfied with surgical outcomes. Conclusions: Reconstruction of large frontoencephaloceles can be challenging due to the need for functional closure of the defect and craniofacial reconstruction to correct medial hypertelorism, long nose deformity, and cephalad forehead rotation. The novel surgical technique presented in this paper allows for reliable reconstruction of functional and aesthetic needs with simplified incision design, osteotomies, and bandeau manipulation.

A 3D-Printed Model-Assisted Cervical Spine Instrumentation after Tumor Resection in a 4-Year-Old Child: A Case Report

2021 ◽  
pp. 1-7
Author(s):  
Marko Jug
Keyword(s):  
Cervical Spine ◽  
3D Model ◽  
Intraoperative Complications ◽  
Tumor Resection ◽  
Upper Cervical Spine ◽  
Spine Instrumentation ◽  
Cord Injury ◽  
Spinal Navigation ◽  
Upper Cervical ◽  
3D Printed

<b><i>Introduction:</i></b> In the case of tumor resection in the upper cervical spine, a multilevel laminectomy with instrumented fixation is required to prevent kyphotic deformity and myelopathy. Nevertheless, instrumentation of the cervical spine in children under the age of 8 years is challenging due to anatomical considerations and unavailability of specific instrumentation. <b><i>Case Presentation:</i></b> We present a case of 3D-printed model-assisted cervical spine instrumentation in a 4-year-old child with post-laminectomy kyphotic decompensation of the cervical spine and spinal cord injury 1 year after medulloblastoma metastasis resection in the upper cervical spine. Due to unavailability of specific instrumentation, 3D virtual planning was used to assess and plan posterior cervical fixation. Fixation with 3.5 mm lateral mass and isthmic screws was suggested and the feasibility of fixation was confirmed “in vitro” in a 3D-printed model preoperatively to reduce the possibility of intraoperative implant-spine mismatch. Intraoperative conditions completely resembled the preoperative plan and 3.5 mm polyaxial screws were successfully used as planned. Postoperatively the child made a complete neurological recovery and 2 years after the instrumented fusion is still disease free with no signs of spinal decompensation. <b><i>Discussion/Conclusion:</i></b> Our case shows that posterior cervical fixation with the conventional screw-rod technique in a 4-year-old child is feasible, but we suggest that suitability and positioning of the chosen implants are preoperatively assessed in a printed 3D model. In addition, a printed 3D model offers the possibility to better visualize and sense spinal anatomy “in vivo,” thereby helping screw placement and reducing the chance for intraoperative complications, especially in the absence of intraoperative spinal navigation.

scholarly journals A Retrospective Review of 589 Percutaneous Tracheostomies in a Canadian Community Teaching Hospital

2021 ◽  
pp. 014556132110257
Author(s):  
Dongho Shin ◽  
Andrew Ma ◽  
Yvonne Chan
Keyword(s):  
Retrospective Study ◽  
Teaching Hospital ◽  
Intraoperative Complications ◽  
Percutaneous Tracheostomy ◽  
Hospital Setting ◽  
Complication Rates ◽  
Safe Alternative ◽  
Neck Extension ◽  
Intraoperative Complication ◽  
Community Teaching

Objective: The primary objective of this study was to review the complication rate of percutaneous tracheostomies performed by a single surgeon in a community teaching hospital. Methods: This retrospective study reviewed the patients who underwent percutaneous tracheostomy with bronchoscopic guidance in a community hospital setting between 2009 and 2017. Patients older than the age of 18 requiring percutaneous tracheostomy were chosen for this retrospective study. Patients who were medically unstable, had no palpable neck landmarks, and inadequate neck extension were excluded. Indications for percutaneous tracheostomy included patients who had failed to wean from mechanical ventilation, required pulmonary toileting, or in whom airway protection was required. Results: Of the 600 patients who received percutaneous tracheostomy, 589 patients were included in the study. Intraoperative complication (2.6%) and postoperative complication rates (11.4%) compared similarly to literature reported rates. The most common intraoperative complications were bleeding, technical difficulties, and accidental extubation. Bleeding, tube obstruction, and infection were the most common postoperative complications. Overall burden of comorbidity, defined by Charlson Comorbidity Index, and coagulopathy were also found to be associated with higher complication rates. The decannulation rate at discharge was 46.3%. Conclusion: Percutaneous tracheostomy is a safe alternative to open tracheostomies in the community setting for appropriately selected patients.

How to Achieve an Accurate Anatomical Femoral Tunnel Technique in ACL Reconstruction in the Early Years of Your Consultancy? Femoral Offset Aimer Technique: Consistent and Reproducible Technique

2019 ◽  
Vol 33 (12) ◽  
pp. 1201-1205
Author(s):  
Pregash Ellapparadja ◽  
Ignatius Joseph ◽  
Veenesh Selvaratnam
Keyword(s):  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Intraoperative Complications ◽  
Senior Author ◽  
Early Years ◽  
Anatomical Location ◽  
Independent Practice ◽  
Femoral Offset ◽  
Tunnel Technique ◽  
Anterior Cruciate

AbstractFemoral tunnel malposition is the most common reason for failure of primary anterior cruciate ligament reconstruction. There are several methods to identify the anatomical location of femoral footprint. Femoral offset aimer technique is one such technique which is easy to use and reliable. It is an ideal technique for junior and inexperienced surgeons to recreate the femoral tunnel in its anatomical footprint. The senior author (P.E.) has been using this technique for 30 consecutive cases in his first year of independent practice during his consultancy without any major intraoperative complications. The author describes this technique in this article with tips and tricks which will especially guide the junior and inexperienced surgeons to avoid running into intraoperative problems while drilling the femoral tunnel.

scholarly journals Absence of Association between Preoperative Estimated Glomerular Filtration Rates and Postoperative Outcomes following Elective Gastrointestinal Surgeries: A Prospective Cohort Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Sivesh K. Kamarajah ◽  
Behrad Barmayehvar ◽  
Mustafa Sowida ◽  
Amirul Adlan ◽  
Christina Reihill ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Glomerular Filtration ◽  
Elective Surgery ◽  
Gastrointestinal Surgery ◽  
Major Complication ◽  
Postoperative Outcomes ◽  
Queen Elizabeth Hospital ◽  
Complication Rates ◽  
Significant Difference ◽  
The Impact

Background. Preoperative risk stratification and optimising care of patients undergoing elective surgery are important to reduce the risk of postoperative outcomes. Renal dysfunction is becoming increasingly prevalent, but its impact on patients undergoing elective gastrointestinal surgery is unknown although much evidence is available for cardiac surgery. This study aimed to investigate the impact of preoperative estimated glomerular filtration rate (eGFR) and postoperative outcomes in patients undergoing elective gastrointestinal surgeries. Methods. This prospective study included consecutive adult patients undergoing elective gastrointestinal surgeries attending preassessment screening (PAS) clinics at the Queen Elizabeth Hospital Birmingham (QEHB) between July and August 2016. Primary outcome measure was 30-day overall complication rates and secondary outcomes were grade of complications, 30-day readmission rates, and postoperative care setting. Results. This study included 370 patients, of which 11% (41/370) had eGFR of <60 ml/min/1.73 m2. Patients with eGFR < 60 ml/min/1.73 m2 were more likely to have ASA grade 3/4 (p<0.001) and >2 comorbidities (p<0.001). Overall complication rates were 15% (54/370), with no significant difference in overall (p=0.644) and major complication rates (p=0.831) between both groups. In adjusted models, only surgery grade was predictive of overall complications. Preoperative eGFR did not impact on overall complications (HR: 0.89, 95% CI: 0.45–1.54; p=0.2). Conclusions. Preoperative eGFR does not appear to impact on postoperative complications in patients undergoing elective gastrointestinal surgeries, even when stratified by surgery grade. These findings will help preassessment clinics in risk stratification and optimisation of perioperative care of patients.

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